title: Oral cGVHD screening tests in the diagnosis of systemic chronic graft-versus-host disease.
abstract: To determine the diagnostic properties of oral manifestations and histological features of graft-versus-host disease (GVHD) screening tests in the diagnosis of systemic chronic graft-versus-host disease (cGVHD). Sixty patients having undergone allogeneic haematopoietic stem cell transplantation were selected. The patients were submitted to a clinical oral examination to assess symptoms and clinical changes in the oral mucosa. Histopathologic analysis of the lower lip oral mucosa (LLOM) and salivary glands (SG) was also performed. Systemic cGVHD was used for a comparison to oral cGVHD. The accuracy of oral cGVHD tests was low for all methods (58.4% and 52.6% for white lesions and white/red lesions, respectively, in the clinical analysis; 50.4% for the presence of oral pain; and 66.8% and 55.1% for LLOM and SG histopathologic tests, respectively). However, the presence of oral pain had good diagnostic properties [specificity: 100.0, 95% confidence interval (CI): 88.0-100.0; positive predictive value (PPV): 100.0, 95% CI: 94.4-100.0; and negative predictive value (NPV): 72.0, 95% CI: 57.3-83.3]. Moreover, SG alterations revealed by the histopathological analysis also exhibited good diagnostic properties (sensitivity: 98.6, 95% CI: 81.5-99.8; PPV: 71.1, 95% CI: 62.1-79.7; NPV: 85.9 95% CI: 32.9-99.4). The clinical severity of oral lesions and histophatological changes in the LLOM did not exhibit adequate diagnostic properties, whereas both oral pain and SG histopathological analysis exhibited adequate properties for the diagnosis of systemic cGVHD. Histological changes in lip oral mucosa and salivary glands together with a clinical manifestation of the disease in the oral mucosa can be useful to determining the systemic cGVHD.
authors.affiliation: Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Renata Gonçalves
authors.initials: RG
authors.lastname: Resende
authors.forename: Jeane
authors.initials: J
authors.lastname: de Fátima Correia-Silva
authors.forename: Telma Cristina
authors.initials: TC
authors.lastname: Arão
authors.forename: João Artur Ricieri
authors.initials: JA
authors.lastname: Brito
authors.forename: Henrique
authors.initials: H
authors.lastname: Bittencourt
authors.forename: Ricardo Santiago
authors.initials: RS
authors.lastname: Gomez
authors.forename: Mauro Henrique Nogueira Guimarães
authors.initials: MH
authors.lastname: Abreu
mesh_terms: D002908:Chronic Disease; D003680:Deglutition Disorders / Q000175:diagnosis; D004890:Erythema / Q000175:diagnosis; D005157:Facial Pain / Q000175:diagnosis; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017512:Lichenoid Eruptions / Q000175:diagnosis; D008047:Lip Diseases / Q000175:diagnosis; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009059:Mouth Diseases / Q000175:diagnosis*; D009061:Mouth Mucosa / Q000473:pathology; D011237:Predictive Value of Tests; D012466:Salivary Gland Diseases / Q000175:diagnosis; D012470:Salivary Glands, Minor / Q000473:pathology; D012680:Sensitivity and Specificity; D013280:Stomatitis / Q000175:diagnosis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014987:Xerostomia / Q000175:diagnosis
chemical_list: D007166:Immunosuppressive Agents